December 2004 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
NACBHD News
March 3-5 Legislative Conference: Strategize with the Public Policy Experts
A Unique Opportunity to Strategize and Form Alliances with Policy Experts
NACBHD's annual Legislative Conference is scheduled for March 3 - 5 at the Jurys Hotel in Washington, DC. This year's conference is a unique opportunity for members to learn first-hand about NACBHD's legislative agenda and priorities, as well as to strategize with public policy experts. SAMHSA and CMS officials will present timely policy information; there will be a session on implementing the Medicare Modernization Act of 2003; the Medicaid Committee will report on its activities as Medicaid Reform looms on the horizon (see related article in this newsletter); and state developmental disability and state substance abuse directors will discuss critical partnership opportunities. For more information on the conference, click here.
Hotel Reservations and Conference Registration
Hotel reservations should be made directly with the Jurys Hotel at (202) 483-6000 or 866-JD Hotels. For information on conference registration, visit the conference area of the NACBHD website, or click here.
Membership Campaign
December marks the end of NACBHD's Membership Campaign Session. While we encourage interested county and county sponsored authorities to join at any time, this is a particularly opportune moment to join. We are celebrating our 10th anniversary and look forward to an exciting year of advocacy and influence and as we work with our policy partners during this critical time in the mental health, developmental disability, and substance abuse communities. And to strengthen county behavioral health authorities' concerns on Capitol Hill, NACBHD is now an affiliate of the National Association of Counties, the official representative of counties and county governments. Click here
for more information on membership benefits and to join.
NACBHD in the Field
NACBHD Executive Director Melissa Staats testified before SAMHSA's National Advisory Council, which met December 7 and 8, in Rockville, MD. The meeting was open to the public; discussions planned included: recently passed legislation, including the use of seclusion and restraints on children in mental health facilities, SAMHSA's HIV/AIDS and hepatitis activities, criminal justice issues, and SAMHSA's American Indian and Alaska Native Activities.
Charles Curie, SAMHSA Administrator provided opening comments to the Council. He stated that establishing services outcomes and the use of health information technology are the most important issues for SAMHSA. Documenting that services improve lives is the only hope for ever achieving a sufficiently funded system. In this "outcomes management environment" Mr. Curie mentioned that SAMHSA will focus on (1) "sub treatment" capacity of the Access to Recovery (ATR) program to create formal recognition that there are many roads to recovery, (2) Mental Health Transformation and the federal role in creating collaboration across the government sectors, and (3) strategic prevention.
Staats' comments can be found here.
Meet Maeghan Gilmore, NACBHD Intern
NACBHD is pleased to welcome aboard Maeghan Gilmore, a student in George Washington University's M.P.H. program. Gilmore began her M.P.H. at Boston University and previously taught high school health education in high school in Michigan. Her primary responsibility is to work with the Developmental Disabilities Committee, and she is becoming familiar with the committee's advocacy and legislative agenda. As part of her work with the DD Committee, she recently attended an IDEA conference committee meeting on the Hill. She also helps with database and membership tasks, and attends some advocacy and policy meetings with Melissa Staats. She works in the NACBHD office Wednesdays and Fridays from 10:00 a.m. to 3:00 p.m., and can be reached at mgilmore@nacbhd.org.
Members: Discount on Manisses Publications Now Available
Manisses Communications, Inc., is now offering NACBHD members substantial discounts (over 50%) on the following publications: Mental Health Weekly, Alcoholism & Drug Abuse Weekly, The Brown University Child and Adolescent Behavior Letter, and Addiction Professional.
Click here for more information and an order form.
Medicaid Reform: The Forecast
Medicaid Reform is on the horizon. Reforming the system by way of block granting was unsuccessfully floated in President Bush's first administration; but it did not have the support of the National Governors' Association or Medicaid advocates. Despite defeat the first time around, there are ample signs that Medicaid Reform will be taken up in the second administration, and possibly, sooner rather than later. As David Wiebe, Chair of NACBHD's Medicaid Committee and Executive Director, Johnson County Mental Health Center, Mission, Kansas, describes the situation, "It is safe to say the administration will follow through on previous plans to reform Medicaid."
While NACBHD's Medicaid Committee is developing a Medicaid Reform platform that addresses the needs of communities, there are already discussions among advocacy groups about the avenues reform might take, and signs in the popular media that large changes in Medicaid may be looming. A November 19 analysis of the $8.18 trillion debt limit reported that Senator Judd Gregg (R-N.H.), who will chair the Senate Budget Committee next year, "said the measure of his success will be 'putting in place a very definitive budget with strong enforcement mechanisms on the discretionary and entitlement [spending] side.'" (Jonathan Weisman, The Washington Post, p. A6) And, House Energy and Commerce Committee Chair Joe Barton (R-TX) recently said that Medicaid will be a Committee priority. "'He wants to put the same kind of magnifying glass on Medicaid that we put on Medicare in this past Congress," Barton spokesperson Samantha Jordan said.'" (CQ Today, Nov.3, 2004, www.cq.com).
Information from the Medicaid Coalition: Possible Avenues for Reform
Melissa Staats recently attended a meeting of the Medicaid Coalition, a group of special population advocates and providers convened by Families USA, to hear insights from staffers and pundits experienced with previous Medicaid reform. A brief overview from that meeting follows:
Medicaid Reform proposals for block granting were defeated in 1995 and 2003. The environment has changed; new strategies must be developed for Medicaid to survive block granting or caps. (In 2003, 48 senators threatened to filibuster any block grant legislation; this approach will not work in 2005.) And, consensus and compromise are now not part of the Hill environment.
Presenters said reform proposals likely might come through the House budget reconciliation process, rather than through the President. The President's budget may be silent on Medicaid reform due to other priorities, such as terrorism and Iraq, tax reform, Social Security reform, tort reform, implementation of the MMA, welfare reform, and the budget deficit - possibly in that order.
Speculation about reform proposals included:
Advocates at the meeting discussed several strategies to address the possible reform attempts, including "real examples" of what the cuts in the Medicaid program would mean.
- A plan to reauthorize CHIP in 2005 instead of 2007, which will allow a proposal to block grant Medicaid, similar to CHIP, and then merge the two programs.
- Budget cuts such that block granting becomes almost a default; there will not be enough money to do anything else.
- Entitlement caps could be placed on the program through the budget reconciliation process. In either of these proposals, cuts could total up to $50 billion.
The County Behavioral Health Perspective on Medicaid
Wiebe notes that Medicaid is experiencing rapidly rising costs, with Medicaid the fastest growing part of many state budgets. From the federal point of view, the interest is to limit federal liability for Medicaid paid by the states. From a behavioral health perspective, Medicaid represents a growing source of revenue over the past few years - over 50% of the cost of public mental health is paid for by Medicaid. In Wiebe's area, Johnson County, KS, over the last 10 years, the portion of the budget funded by Medicaid has increased from 10-12% to over a third. When Wiebe talks with his colleagues, some report they are funded at up to 70% by Medicaid.
The fixed amount of money to states under the block grant proposal would give states more flexibility with their programs. Consumer advocates view this as a way for states to restrict eligibility or to cut benefits, including restricting "optional" social services essential to individuals to live in the community, while maintaining traditional medical services. And, the previous Medicaid Reform proposal included a "sweetener" of $10 billion floated to the states, but states would have to repay it in 10 years.
"Closing the gap" and making Medicaid available to the uninsured is also a possibility; however, there is a concern that this will "water down" benefits and that behavioral health could be at risk.
The Medicaid Committee met recently to discuss proposals that protect and enhance services in communities, should Medicaid reform take place. Wiebe notes that a central concern is protecting the ability of the most seriously mentally ill to access the services that are so essential to a life in the community.
NACBHD Platform on Medicaid Reform
The Committee determined that two documents are still relevant as a foundation for a comprehensive reform platform. The Resolution on Medicaid Reform (2000), supported by NACo, identifies 13 principles that Congress should adopt when considering reform. And, NACBHD's Medicaid Survey: Preliminary Findings and Proposed Strategies (2002), is based on a survey of the NACBHD membership and contains a four-part strategy to ensure that county government perspective is included in Medicaid policy and reform. Revisions that recognize the impact of maintaining current regulatory requirements in a block grant environment will be addressed. And, part of comprehensively addressing Medicaid will be including the perspective of the developmental disabilities community. The committee also will include Medicare in the scope of its activities; counties will be forced to pick up the state share for dual eligibles as this group transitions to Medicare when the MMA is implemented in 2006.
To thoroughly develop a Medicaid platform that addresses communities' needs, a member survey will be developed to document the role of county government in the Medicaid system, including information about the various structures in different states and how Medicaid money and non-match money are generated and the flow. Total dollar amounts will be obtained. The effort will require the support of NACo and the National Governors Association. Information gained in the survey will help NACBHD establish legitimacy on the Hill.
In addition to the ongoing work by the Medicaid Committee, Bob Egnew, NACBHD's policy consultant, is working on a paper that addresses Medicaid concerns, which will build on the existing Medicaid documents mentioned above, for discussion at the March 3-5 Legislative Conference.
NACBHD will keep members informed about Medicaid Reform as more information becomes available.
Medicare Update
NACBHD's Medicaid Committee is including Medicare in its purview, and will follow the implementation of the Medicare Modernization Act of 2003 (MMA) and, in particular, its effect on dual eligibles. In addition, there will be a session on implementing Medicare law at the March 3-5 Legislative Conference. NACBHD will keep members informed about the impact of the law in their communities and will continue to advocate for a positive outcome for counties and those they serve. (For an overview of the concerns and advocacy efforts related to the MMA, see the October 2004 newsletter.)
Update on the Campaign for Mental Health Reform
NACBHD spoke with Bill Emmet, project director at the National Association of State Mental Health Program Directors, and project director for the Campaign, about recent Campaign activities.
Mental Health Screening for Children
As reported in the October newsletter, the Campaign has been actively addressing mental health screening for children and has developed a consensus statement about the process. Children's mental health screening is called for in the Final Report of the President's Commission on Mental Health; however, considerable controversy and misinformation about screening processes, such as the Illinois Children's Mental Health Partnership, has been generated in various advocacy groups. In addition, there was an effort not to fund the Transformation State Incentive Grants (which would have a plan for screening) unless they did not include screening for children, or unless screening without parental consent was deleted. (Emmet notes that screening without parental consent and universal or mandatory screening were never under discussion.) Congressman Ron Paul (TX) first attempted a rider that would prohibit screening, but that was voted down 300 - 95. Subsequently, he came up with a free-standing bill with the same intent. Although the bill may never come to a vote, Emmet explains that it still manages to keep the issue alive. While the Campaign groups involved had individual concerns about screening, they demonstrated their solidarity behind the statement by endorsing it across the board. The consensus statement, "Early Detection of Mental Health Problems in Children and Adolescents" is available on the Campaign website at www.mhreform.org, and has been disseminated to the Campaign's partners. Bulleted points describe what screening is and emphasize that screening does not produce a diagnosis, and provide issues communities beginning school-based early-detection programs should address.
State-Informed Federal Policy Initiative-the "Call to Action" The Campaign's project to gather information on state and local transformation efforts and determine the implications for federal policy is on schedule, with an internal draft of findings (for comment by the Campaign partners) due soon, and a final document, or "Call to Action," planned for January. Emmet notes that the Call to Action will include examining "radical" ways in which the federal government can provide leadership in the transformation process and in improving mental health services in this country, such as the action inherent in the Community Mental Health Act of 1964. The Campaign is also following the implementation of Proposition 63 (see article in this newsletter); Emmet says Proposition 63 "should send a message to the states and federal government that there is great popular support for mental health services."
SAMHSA Action Agenda
The Action Agenda could be released at any time, possibly by the end of the year.
SAMHSA Reauthorization
SAMHSA reauthorization is a 2005 activity. The Call to Action should inform how reauthorization will look.
Post-election Issues
The Campaign will keep a careful eye on and be prepared to respond to some of the proposals that surfaced in the first term of the Bush administration and are expected to resurface and be acted upon quickly, such Section 8 vouchers and block granting Medicaid.
Legislative Activity
The following legislation was signed into law by President Bush.
NACBHD's Developmental Disabilities Committee Develops 2005 Legislative and Advocacy Agenda
The Developmental Disabilities Committee recently reestablished monthly meetings by conference call and is concentrating on several critical priorities for the developmental disabilities community. During their most recent call, the group delineated priorities and developed a legislative agenda, and is preparing to advance county-based developmental disabilities interests on the national front. Says NACBHD Executive Director Melissa Staats, "I'm really excited about moving the committee forward and to its being more visible in Washington."
Committee chair Lynn Ferrell, Executive Director of Polk County Health Services in Des Moines, Iowa, outlines the committee's focus:
Ferrell urges members with developmental disabilities services within the scope of their activities to join, or, to help identify and recruit their local counterparts for membership. Contact Lynn Ferrell at lynn@pchs.co.polk.ia.us or Maeghan Gilmore at mgilmore@nacbhd.org.
California's Proposition 63 Passes: What's Next?
An Historic Moment for Public Mental Health in California
On November 2, California voters passed Proposition 63, an initiative authored by Assembly member Darrel Steinberg and supported by a large coalition of elected representatives, the mental health community, doctors, nurses, teachers, police, firefighters, organized labor, and thousands of individuals. The initiative, which passed by a 54 to 46 margin, is a historic move for California public mental health. It will provide money for public mental health by a 1% tax on taxable personal income over $1 million, representing $600 million to $1 billion per year in additional funding for public mental health in California. According to NAMI, the projected funding breakdown over the next few years is as follows: $250 million for 04-05, $680 million for 05-06, and $700 million in 06-07, with increasing amounts thereafter. (www.nami.org, "Proposition 63 Passes in California," November 4, 2004).
Patricia Ryan, Executive Director, California Mental Health Directors Association, and NACBHD member, says, "Credit has to be given to Darrell Steinberg and Rusty Selix [Executive Director, California Council of Community Mental Health Agencies] for coming up with the idea to get the initiative written." Steinberg went "anywhere and everywhere to convince people to vote for this." In addition, fundraising groups canvassed the state to get the initiative qualified for the November ballot. While Scientology produced several "hit pieces," there was not much funded opposition to the initiative.
Next Steps
Ryan says that there is a lot of discussion in the state department of mental health about developing guidelines for the new initiative based on a recovery model (as in the Final Report of the President's Commission on Mental Health), what services fit into it, and how the money is going to be distributed. The President's Commission's recommendations dovetail with the initiatives of the Proposition, with an emphasis on evidence based practices, cultural competence, and initiating the key recommendations as a goal.
Taxes start being collected January 7, 2005 and will be available the first quarter. This first money to state and counties will be for planning, what Ryan calls "planning for the plan." (Money is available for capital and information technology in 2005, and counties must assess need in these areas.) While no program money is available until 2006, counties can borrow against what they expect to receive to get started earlier rather than later.
The proposition requires the development of a new commission to approve certain county programs and expenditures, and counties are required to have an inclusive stakeholder process for their plans to be submitted for state funding. All mental health stakeholders in California want to be involved in the Proposition - including those responsible for statewide mental health planning, county mental health authorities, community mental health agencies, consumers and families. The state is working on developing a consistent methodology for assessing unmet need, how to meet it, and when. Ryan says, "It's a little overwhelming for counties and the state to figure out what next steps to take."
Key Provisions of Proposition 63
Ryan reports on the several key provisions of the bill:
Each county must develop a plan for each component, in conjunction with stakeholders in their community, and submit a three-year plan to the state for the number of consumers they are planning to serve. The three-year plan is to be updated annually and is funded annually.
Challenges
Ryan reports that there are a few challenges. For example, the funding is not intended to replace federal, state, or local funding, and the initiative is written so that it prohibits supplantation at the state level; the state has to provide the same level of funding it did as of the date of passing the initiative. However, the state is trying to get around the supplantation language.
Competition for what should be funded is expected. For example, there is competition in innovation and prevention in regard to flexible funding for AB 1421, the involuntary outpatient bill, which was passed a few years ago. The strong consumer constituency will push for consumers and for home peer support and self-help.
Ryan says that the passage of Proposition 63 is and "exciting opportunity for county mental health directors. People saw that it was a broken system and they would have to find another way to fix it. It is a little overwhelming to think of rebuilding the mental health system after several years of decline." And she says, it is "exciting, groundbreaking. We just have to make sure we do it right."
North Carolina Member Organization Wins Five-County Demonstration Plan Aimed at People with Disabilities Directing Their Own Care
A five-county North Carolina demonstration plan, awarded under the CMS Independence Plus Initiative, aims to make it easier for individuals with developmental disabilities and cognitive impairments to direct their own care by giving them greater control over a range of Medicaid services. Dan Coughlin, a NACBHD member, is Area Director and CEO, Piedmont Behavioral Health Care, in Concord, NC (20 minutes from Charlotte), and represents the five counties involved in the demonstration plan: Cabarrus, Davidson, Rowan, Stanley, and Union counties. Coughlin, a 30-year veteran of behavioral health and previous chair of the New York State Conference of Mental Hygiene Directors, spoke with NACBHD about this significant demonstration project and its backdrop, statewide behavioral health reform in North Carolina.
Reform in North Carolina
Coughlin came to North Carolina at the beginning of the reform movement four years ago. Reform is a major transformation of the way services will be delivered across North Carolina, with current Area Programs changing their nature as both managers and providers of care to become Local Management Entities (LMEs) that focus on local system management and network development. In addition, statewide reform has forced some degree of consolidation of Area Programs because policymakers perceived there were too many local authorities.
And Coughlin reports, the intent of reform is to structure the system so as to broaden the care that can be delivered. The state rewrote its Medicaid program to expand the community support plan and best practices, and to build a better crisis system across disability and age categories. Coughlin says many local programs have wanted to do this, and could not for a variety of reasons. He says North Carolina needs to do a better job of managing resources, but also needs to modernize the system of care and infuse flexibility and continuous evolvement of emerging best practices. However, there are not a lot of models for doing this. Coughlin believes the state has needed a broad reform for structuring both how services are delivered as well as in terms of where in the system to locate authority and management. In picking a path for reform, the state rejected state take over, privatization, and county governments as the locus of control in favor of redesigning its existing authorities, which are public authorities and political subdivisions of state government. Coughlin says the salient policy question has been, "Is there a way to reorganize that gives the existing (consolidated) governing structure tools to manage limited resources against defined benefits, against targeted populations, and against defined outcome?" And, he says, "We at Piedmont think the answer is yes. Our model is a managed care model operated by a public sector entity." Coughlin describes a public sector entity (LME) as a private, not-for-profit model - with the ability to make decisions quickly, while retaining public accountability and public policy priorities.
Coughlin notes that this allows an opportunity to reinvest dollars and grow needed, innovative programs and "do that thing that people have talked about for 15 years-employ private sector managed care tools to make better public health policy. We do systems management and providers provide care. We write the checks; and because we control the checkbook, we can disincentivize providers from maintaining the status quo and we can incentivize them to develop new, best practice models of care."
Specifics of the Demonstration Plan
Coughlin describes Piedmont as the state's only local system that is fully capitated across all three disabilities as a prepaid managed healthcare plan entity. Piedmont has an area population of 650,000 and an annual budget of $130 million. Piedmont will be the only such plan until the state sees how they are doing.
The CMS waiver is a 1915 BC combination waiver, with B for mental health and substance abuse services, and C for developmental disabilities services. B is the Cardinal Plan and C is the Innovation Plan. The waiver will provide:
The waiver allows consumers and families to determine how they will use the Medicaid dollars assigned them through individual benefits plans - they will be able to pick and choose their benefits package. More broadly, the B and C combination of how the Medicaid dollars are used is considerably expanded in terms of community services, with more flexibility around how the Medicaid dollars are used. Innovative new services not in the state taxonomy may be approved by CMS. There are stings attached-new programs may not cost more than traditional services in the statewide plan. Coughlin says the fact that they manage the dollars gives them tremendous flexibility in the area of out-of-home placements for children; currently many dollars are spent on the placement of children. Piedmont wants to build community-based programs to keep children in their own homes and their own schools, with aggressive intervention and wrap-around services that are models of best practices.
Other examples of the flexibility the waiver allows are in ICF and inpatient care. For example, Coughlin and his staff will look for local hospitals to develop inpatient programs specifically designed to serve people that are severely or persistently mentally ill or who have other complex, hard-to-treat conditions and who tend to use high cost services. Piedmont will expect these services to genuinely integrate into the larger emerging community system of services that is recovery-focused, and will be willing to pay rates that reflect that quality of care. Again, they control the dollars and can start what Coughlin calls "the drive to shape the system." Almost all of their institutional care happens because of a lack of care in the community. They can change that because they can take dollars out of institutional care and build community capacity.
Funding and Timeline Specifics of the Waiver
It is a three-year waiver, beginning April 1, 2005, with two parts--Medicaid dollars, and state and county dollars as well. The Medicaid waiver is for three years, and the state side of the plan is parallel to the three-year timeframe, with the state dollars capitated in a model that breaks the barriers between the three disability groups. Both are eligible for reapplication, for up to five years.
Coughlin describes determining the capitation amounts as a very technical exercise which involved retrospective actuarial work. Actuaries for both Piedmont and for the state looked at the historical spending and made projections about population growth and inflationary factors. They then estimated and assigned rates in all categories to reach and overall capitation. Because the plan will allow easier access, Piedmont forecasted that they will be serving significantly more people over time. Their capitation and the state's capitation rate projections were very close. Out of the approximately $130 million forecast, about $70 to $80 million will be Medicaid and the remainder will be state for each year.
Concerns and Challenges
For More Information on the Piedmont Demonstration Plan and Reform in North Carolina
For more information on Piedmont's demonstration program and reform in North Carolina, see
www.piedmontbhc.org. Click on "Business Plan," for what Coughlin describes as the "nuts and bolts description" of what the demonstration is doing. For a review of reform in North Carolina from NACBHD member Carol Duncan-Clayton, Executive Director, North Carolina Council of Community Programs, see the February 2004 newsletter.
NACo Drug Discount Cards: Pilot Program Underway
The National Association of Counties recently implemented a pilot prescription discount card program. Nearly 30 counties will participate in the pilot program, which will be evaluated for value and effectiveness, with the goal of expanding the program to other NACo counties throughout the nation.
Andrew Goldschimdt, NACo Director of Membership, reports that Caremark/Advance PCS was chosen as the program provider after a two-year process that involved the NACo membership committee, a special evaluating committee, and a consulting firm. Caremark/Advance PCS was selected for cost savings and for ease of use and understanding, with 54,000 pharmacies nationwide where the cards may be used. Savings average 20%, with a savings of 13-35% on purchases at local pharmacies, and a savings of up to 50% on mail order purchases. Anyone can use the cards, including senior citizens, the elderly, and the uninsured. Counties may use the cards for jail populations or for their employees if they do not have a prescription drug insurance program. The cards present no cost to NACo, no cost to counties, and no cost to consumers using the card. No paperwork is involved for consumers; and therefore, counties do not have databases on who has the cards. Cards are given out with brochures and can be used immediately.
While the program is currently limited to the pilot participants, if successful, it will be expanded to NACo member counties in 2005. For more information, contact Andrew Goldschimdt at agoldschimdt@naco.org.
Bush Chooses Michael Leavitt to Head Health and Human Services
By Mark Stencel
Washington Post Staff Writer
Monday, December 13, 2004; 12:42 PM.
President Bush today turned to his Environmental Protection Agency administrator, Mike Leavitt, to lead the Department of Health and Human Services, a role that would put the former Utah governor in charge of Medicare, Medicaid and federal welfare programs.
In choosing Leavitt to run one of the largest departments in the federal government, Bush has selected a trusted friend and a fellow former governor who also is a former chairman of the National Governors Association.
SAMHSA's Evidence-Based Practices Toolkits Available Soon
SAMHSA's Evidence-Based Practice Implementation Resource Kits will be available within weeks. The six kits, part of the SAMHSA/CMHS science-to-services strategy aimed at encouraging evidence-based practices in mental health, contain the following resources: information sheets for all stakeholders, introductory videos, practice demonstration videos, and a workbook or manual for practitioners. SAMHSA and CHMS plan additional practices for future kits. Check www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/ for more information on the these six Resource Kits: Illness Management and Recovery, Medication Management Approaches in Psychiatry, Assertive Community Treatment, Family Psychoeducation, Supported Employment, and Co-occurring Disorders: Integrated Dual Diagnosis Treatment.
NIAAA Announces New Website for Middle Schoolers
The National Institute on Alcohol Abuse and Alcoholism has launched the new website, "The Cool Spot," for 11-13 year olds. The easy-to-use site integrates games and graphics to present information about the risks of underage drinking and how to prevent peer pressure. According to NIAAA's November 16 press release, more than 4 in 10 youngsters who start drinking before age 15 eventually become alcohol dependent.
The study demonstrated that teens tend to overestimate how much other teens drink; but when provided with accurate information, they may feel less pressure to drink. Teens can explore this issue through the following areas of the site:
To access the site, see www.coolspot.gov.
